Transcript Chapter 2 Building and Sustaining Strong National Health

Chapter 2
Building and Sustaining Strong
National Health Research Systems
World health report 2012
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Kazem Heidari
PhD student of epidemiology
Knowledge Utilization Research Center;
Tehran University of Medical Sciences
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Introduction-An Overall Framework
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Research improves health through three primary paths
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Better products and services
Evidence-informed policies and practice
Empowering people towards healthy behaviors
The mechanisms through which these goals are
achieved are a set of activities which occurs within an
entity called a national health research system (NHRS)
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Introduction-An Overall Framework
 NHRS
requirements to achieve the desired goals
A sound conceptual framework and a pragmatic
strategy
 An ability to monitor and evaluate its own progress
 An appreciation of the forces beyond research which
needs to be in place for success.
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Introduction-An Overall Framework
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Introduction-An Overall Framework
 The
movement towards a stronger NHRS is
driven by its three primary constituencies(and
beneficiaries) or stakeholders:
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2.
3.
Researchers (in the public and private sectors);
health professionals;
People: patients and the general public;
Decision- and policymakers(including health
system managers).
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What is a National Health Research
System? Who Are Its Key Stakeholders?
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Responsibility of countries to promote activities to strengthen
NHRS
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Improvement of the knowledge base for making decisions
Setting priorities
Managing research
Monitoring performance
Adopting standards and regulations for high quality research and its
ethical oversight
Ensure participation in such activities of the community,
nongovernmental organizations and patients.
The research system should be seen as the 'brains' of the health
system - a means to analyze, understand and improve the health
system.
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What is a National Health Research
System? Who Are Its Key Stakeholders?
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An integrated and holistic 'systems' approach to health
research is arguably a rational approach to maximize its
value and impact.
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The health system, in turn, must also inform the health
research system.
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For example, reliable, accurate and accessible health
information, is critical for informing priority research agendas
and as a means of tracking the impact of research.
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What is a National Health Research
System? Who Are Its Key Stakeholders?
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How the three stakeholder groups can effectively
contribute to the overall system (UK experience)
 The diverse needs of the various groups must be
addressed
 A facilitating mechanism at the interface between the
health research system and its various stakeholders
should be developed
 Additional resources should be allocated to expand
the scope of the health research system while
maintaining support for basic science
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Four principal functions of NHRS
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What is a National Health Research
System? Who Are Its Key Stakeholders?
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Stewardship can be seen as the 'umbrella' function of a
NHRS
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The overall organization and governance of a NHRS needs to
be established in order to deliver to coordinate and monitor
the system so that it delivers the expected results and
benefits.
The effective implementation of the functions of the
NHRS can, in turn, be considered in by identifying the
building blocks or key capacities for such a system.
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Key capacities needed for NHRS
1.
Setting relevant research priorities -allocation of
resources
2.
Building and strengthening research capacity - people
and institutions
3.
Defining norms and standards - rules of the game
4.
Translating knowledge into actions which can improve
health outcomes.
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Tools for priority setting
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Combined Approach Matrix (CAM): by Global Forum for Health
Research, public health and institutional dimension
COHRED: by using ENHR (Essential National Health Research)
strategy which takes into account four criteria: appropriateness,
relevance, chance of success and impact of the research outcome.
CHNRI group (Child Health and Nutrition Research Initiative):
 Applied successfully in developing country settings and with
different childhood diseases.
 Focuses on the principles of legitimacy, fairness and inclusiveness
 Provide scores to individual questions against pre-defined criteria
with technical experts independently scoring each research option.
 The process identified twenty 'universal challenges' in setting
priorities in health research
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Setting National Health Research
Priorities
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The COHRED approach to research priority setting
seems to be the most appropriate for health systems
and policy issues for which it is important to consult
policymakers, managers and other stakeholders
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Setting National Health Research
Priorities
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Another approach uses a cost-effectiveness analyses of
medical research as a means to set research priorities, using
a 'value of information' perspective.
 These kinds of objective approach to priority setting are
not desirable, but could be improved by including a
subjective component (e.g. stakeholder consultation).
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Priority setting in health research is a dynamic process and
strongly influenced by local context and capacities.
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Setting National Health Research
Priorities
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It is unrealistic to try and decide which of the various
methods developed is 'the best' one, and it is most
likely that no one size fits all
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Instead, it is suggested that a checklist approach be
considered where the use of a particular priority setting
tool is only part of the armamentarium.
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Setting National Health Research
Priorities
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Commonly, criteria can be categorized
into one of three dimensions:
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Public health benefit (should we do it?)
feasibility (can we do it?)
Cost
Participants in the priority setting
exercise should decide by consensus on
appropriate criteria at the beginning of
the exercise
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How Brazil set their priorities for
health research
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Key lessons learnt and recommendations
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The need to have broad and inclusive consultation.
The National Agenda of Priorities in Health Research needs to be
updated periodically to accommodate new technological advances and
new scientific knowledge, as well as the changing epidemiologic profile of
the Brazilian population,
The Ministry of Health played a key role in setting up and implementing
the Agenda.
Many barriers were encountered and partially overcome.
The financing mechanisms available at the MoH aren’t adequate to
sponsor research projects and the bureaucracy involved hinders the flow
of resources in a timely fashion.
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Setting National Health Research
Priorities
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Challenge of finding the appropriate balance between
investing in biomedical, clinical, educational, public
health and health systems and policy research where
resources are limited.
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The ratio of biomedical research to the rest
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Probably 9 to 1 in developed countries
Ought to be the converse in low income countries as applied
research is more likely to provide a good return on
investment where resources are very limited.
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Setting National Health Research
Priorities
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Importance of incorporating rigorous evaluation alongside major
policy innovations and programmes
 Such an evaluation needs to be planned in advance not added
as an afterthought - which makes adequate evaluation
impossible.
At a higher level of governance, the setting of appropriate
priorities should be guided by a robust national health research
policy.
In many countries, the development and implementation of such
a policy is entrusted to a national health research (or medical
research) council or other similar body
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Key capacities needed for NHRS
1.
Setting relevant research priorities -allocation of
resources
2.
Building and strengthening research capacity - people
and institutions
3.
Defining norms and standards - rules of the game; and
4.
Translating knowledge into actions which can improve
health outcomes.
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Building and Strengthening Research
Capacity
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Capacity is not solely an individual attribute but it implies
effectiveness, ability and, most importantly, sustainability.
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Capacity strengthening refers to improvement in individual or
institutional capabilities within a broader system - and implies
purposeful investments and efforts directed at achieving practical
results and outcomes.
Several levels and dimensions.
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Individual researchers
Research organizations/institutions
There is also receptor capacity which refers to the ability of policy makers
and health professionals to use, and even demand, research findings
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Building and Strengthening Research
Capacity
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additional elements
Research networks serve to link organizations and/or
researchers within countries for conducting research and
relating it to implementation and policy;
These inner levels are further embedded within a national
institutional framework defined by the intersection of
government policies, funding priorities and administrative
systems
The capacity within NHRS to link national to international
research networks are critical, especially in developing
countries and in the face of the rapid advances in knowledge.
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Building and Strengthening Research
Capacity
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Capacity strengthening should be seen in the context of a system,
i.e. capacities are needed across the entire spectrum of the
NHRS.
Several key areas for capacity
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Generation of knowledge - researchers and others who perform primary
research in a range of disciplines from biomedical to health systems
research;
Synthesis of research through systematic reviews- often described as
'secondary' research, and a critical tool for decision making;
Knowledge translation-turning knowledge into evidence-informed policy
and practice, as well as for effective public communication of research –
the need for a cadre of 'knowledge brokers';
Manage and monitor the research system itself
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The core skills and capacities needed
for individual researchers
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Capacity for research synthesis and translation
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Areas often neglected in both developed and developing
countries.
The skills needed here include
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Accessing scientific publications (including those in the 'grey' literature)
Capabilities to do systematic reviews and meta analysis
Development of guidelines, research summaries and policy briefs.
NHRS should address the roles of all actors and participants in
the research process, not just the academic researchers in
universities or research institutions.
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The participation of nurses, community health workers, policy makers,
NGO's and consumers/patients and communities in both the planning
and performance of research.
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Building and Strengthening Research
Capacity
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Many NHRS in developing countries face the problem
attracting and retaining staff in the public research
sector
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Brain drain of their best scientific talent, mostly to the developed world
or to the private sector.
Better incentives (e.g. good career structure, appropriate rewards, respect,
grant schemes for young scientists, etc) as well as innovative schemes to
attract back the scientific diaspora working outside the country
A meritocratic career structure, mentoring and regular appraisal together
with transparent promotion criteria is vital to sustain a high quality
research workforce.
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Building and Strengthening Research
Capacity
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At the institutional level, infrastructural capacity is needed to support
the individual researchers to pursue their research
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Beyond individual institutions, effective networking and a coherent
national framework between institutions within countries is important.
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Networking also extends to international networks
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The all important capacity to monitor and evaluate the performance of
the NHRS itself needs to be developed within the NHRS
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Another key dimension :the capability to disseminate research findings
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Ten recommendations for building, strengthening and
retaining research capacity
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Framework for Designing and Evaluating a Health
Research Capacity-Building Programme
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Thank You!
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